Tuesday

The pharma world's newfound zeal for slimmer pipelines has brought an end to once-promising obesity medicines.

Both Sanofi and Novartis have halted work on experimental weight-loss treatments, leaving rival Novo Nordisk with little competition in the field.

Escalating pressure to lop off lemons and focus on blockbusters-to-be in fields like cancer could slow efforts to tackle one of the world's most pervasive health problems. Despite attempts to rein in the epidemic, obesity rates have tripled since 1975 with some 700 million sufferers at increased risk of heart disease, diabetes and cancer. The ultimate medicine to melt fat -- a potentially lucrative goal researchers have pursued for decades -- has been elusive.

Sanofi last month dropped an obesity medicine it was testing in diabetes patients, along with a second combination of two drugs that has also shown promise in cutting weight. Patients endured too much nausea and vomiting, according to John Reed, Sanofi's new research chief.

"The first attempts at designing those were off target," he said in an interview. Obesity is an "exciting frontier, although not without its challenges."

Existing drugs, including Novo's Saxenda, usually deliver weight loss between 5 percent and 10 percent. To have a profound impact on patients as well as profits, the next generation may need to climb into the double digits. That would come closer to weight-loss surgery, operations that often reduce stomach size and can help patients shed roughly a third of their mass.

The treatment Novartis ditched last year in mid-stage tests didn't yield enough weight loss to justify further work, Jay Bradner, Novartis's research head, said in October. The drug was designed to block two proteins involved in absorbing sugar in the kidneys.

The Swiss pharma giant is expanding in the market for gene therapies that may cure devastating diseases and expects to have seven programs in the clinic over the next year. French rival Sanofi at the same time is accelerating a push into areas such as oncology.

There's no guarantee their obesity medicines would have worked if the research had persisted. One of the main challenges for the field is figuring out how to safely stimulate the amount of energy the body burns while curbing appetite, according to Denmark's Novo Nordisk, which also halted work on a pair of experimental weight-loss drugs last year.

Even before the cuts, the industry's obesity pipeline was "surprisingly thin," according to a Sanford C. Bernstein & Co. report last year. More competition could actually provide a spark and strengthen the case that obesity is a disease requiring medical treatment -- not just diet and exercise, said Novo Chief Science Officer Mads Krogsgaard Thomsen.

Most of the drugs in the field are variations on human hormones involved in appetite and metabolism. With a new treatment aimed at GLP-1, a hormone produced naturally that controls appetite, Novo aims to attain weight loss closer to 15 percent. That would build on Saxenda, which is projected to achieve billion-dollar status in 2021, six years after its launch. It's also moving ahead with a number of early-stage medicines.

"We'd welcome other industry peers to join us," he said.

Overcoming the body's tendency to resist weight loss and minimizing digestive side effects are among the hurdles for researchers, said Fatima Cody Stanford, a doctor and obesity specialist at Harvard University. What's more, a lack of coverage among insurers and a perception of obesity as a lifestyle problem have hindered progress.

"Most of the world has yet to really embrace obesity as a disease," she said.

Still, a number of new candidates are advancing, according to Stanford. One is a medicine Eli Lilly & Co. is testing in diabetes that last year showed an average reduction of as much as 12.7 percent in weight. The Indianapolis-based drugmaker could help bring credibility to the sector on the back of its positive results, said Wimal Kapadia, a Bernstein analyst in London.

Sanofi pulled obesity pill Acomplia in Europe about a decade ago amid concerns about side effects such as suicidal thoughts and depression. After the recent trim, the drugmaker has another potential weight-loss treatment set to enter the clinic soon that may prove to have a better balance of components, said Reed, who joined the company last year.

"We haven't given up yet," he said.

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